Healthcare Provider Details

I. General information

NPI: 1205610797
Provider Name (Legal Business Name): ZITONG QIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GRAND ST
NEW YORK NY
10002-7477
US

IV. Provider business mailing address

4310 CRESCENT ST APT 1806
LONG ISLAND CITY NY
11101-4260
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-1970
  • Fax:
Mailing address:
  • Phone: 202-899-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120030
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: